When I asked Teresa Schnorr why we should be worried about the loss of a little-known occupational health data gathering program, she quoted a popular saying in the field of surveillance: "What gets counted, gets done."
Schnorr, who serves as director of the Division of Surveillance, Hazard Evaluations and Field Studies at CDC's National Institute for Occupational Safety and Health (NIOSH), was referring to the Adult Blood Lead Epidemiology and Surveillance program (ABLES), a state-based effort that collects and analyzes data on adult lead exposure. For more than two decades, NIOSH has been partnering with states to collect such data, which guides local health officials in shaping effective outreach and prevention strategies and helps pinpoint workplaces in need of regulatory intervention. According to the latest CDC data, the prevalence of elevated blood lead levels among adults — which are work-related in 95 percent of cases — declined from 14 per 100,000 employed adults in 1994 to about 6 per 100,000 in 2009.
Unfortunately, those gains could now be in jeopardy. As of August and due to sequestration, there will be no more federal funding for ABLES, Schnorr told me. What that means for the 40 states that receive federal ABLES funds will vary according to each state's budget and funding constraints; however, many states do depend on the NIOSH funds to keep the program afloat. As of 2010, more than 31,000 U.S. adults had blood lead levels higher than 10 micrograms per deciliter, the recently updated definition of elevated blood lead level. Lead exposure can result in cognitive dysfunction, adverse reproductive outcomes, and cardiovascular and kidney damage, with both acute and chronic health effects.
"Obviously, we're saddened that we're losing the opportunity to continue to track this...we're now looking at other alternatives to address occupational lead exposure, but at this point it's unclear what those might be," Schnorr said. "We're all still sorting it out and we're hopeful that we can do something so we can continue to track what's happening with lead."
ABLES is one of those relatively inexpensive public health programs with the potential to yield significant health outcomes and reduce medical expenditures. NIOSH provided a total of $812,500 to 40 state ABLES programs annually, with each state receiving funds based on its needs. Schnorr said it wasn't much, but it was enough to allow states to conduct follow-up and build their occupational health capacity. In fact she said for many state health departments, ABLES was the primary occupational health activity.
In Pennsylvania, federal ABLES funds meant that until very recently the state health department had one staff person dedicated to the effort who could do follow-up and intervention into lead exposure cases. But with the sequestration-mandated cut, there's only enough money for one part-time staff person — and that position may only last for the next one to two years, said James Logue, director of the Division of Environmental Health Epidemiology at the Pennsylvania Department of Health.
"But when that money is gone, I don't know what the future will bring," Logue told me.
Pennsylvania's been involved in ABLES since 1992, and Logue described it as a "priority program in environmental health." He said the state is a leader in adult blood lead level testing, with about 20,000 tests conducted every year that yield about 1,000 new cases of potentially hazardous blood lead levels. Pennsylvania workers particularly at risk of lead exposure include those in the battery manufacturing industry, smelters and construction workers. (According to NIOSH, occupational lead exposure mainly occurs among battery manufacturing, lead and zinc ore mining, and painting and paper hanging.)
Like many state ABLES program, Logue said Pennsylvania's effort works closely with the health department's childhood lead poisoning program as well as with OSHA — "we're the advisors, but the real regulatory group here is OSHA. So it's possible that if we do see an unusual trend in a group of workers, part of the intervention could be alerting OSHA," he noted.
"But if you don't have the program to follow these trends...it can have a serious impact on public health," Logue said. "This is a national situation and it's not good in terms of follow-up on adult excess elevated blood lead levels. I don't know how the states will continue to do it."
Rick Rabin called the ABLES data "invaluable." For about 20 years, Rabin served as the Lead Registry coordinator with the Massachusetts Division of Occupational Safety. He told me that he and his colleagues used ABLES data to conduct follow-up with workers and employers and to help companies reduce their lead exposure risks. Over the years, he noted, the state saw declines in adult blood lead levels among construction workers and particularly among larger construction companies. (Unfortunately, he said due to minimal OSHA enforcement measures, the same declines didn't appear among residential painters.)
"The research over the last 20 years shows that lead is harmful at just about any level we can measure and not just for kids, but for adults as well," said Rabin, who now works as a trainer and technical consultant at the Massachusetts Coalition for Occupational Safety and Health. "It's real bad news."
Rabin said he suspects that without ABLES funding and the data collection it facilitated, it will get much harder to enforce safe workplace standards.
"I would expect that OSHA and other programs that assist workers, particularly those in construction, are going to be much less able to target companies and industries that have high lead exposure," he said. "That might not happen immediately because we have good data for now...but an immediate problem would be if a company is poisoning workers now or next year nobody will know about it."
Sharon Watkins, a member of the Council of State and Territorial Epidemiologists' Executive Board and the organization's lead on occupational health, injury and environmental health, said she's also worried that lead exposure-related referrals to OSHA will decrease in some states or disappear all together. She told me that for many states, federal ABLES money is the only source of funding for adult blood lead surveillance.
And while occupational lead exposure doesn't come with the morbidity and mortality of other workplace hazards, such as falls and motor vehicle crashes, Watkins noted that "it's entirely preventable."
"I think (ABLES) has been critical," said Watkins, who also serves as chief of the Bureau of Epidemiology at the Florida Department of Health. "It started more than 20 years ago to fill a gap and over the years it's grown to include most states and is generating reliable and consistent data. I think the program has strengthened what states are able to do, has initiated interventions and has really affected worker health."
In Florida, federal ABLES funding meant the state could dedicate one part-time worker to the effort, Watkins said. Without the funding, she said it'll be a struggle to continue.
"When we're not consistently looking at the data, it's hard to say what the true numbers are or what the trend is," Watkins told me. "There's always emerging industries and as we grow our manufacturing sector in the U.S. new things are always popping up, so I don't think we should just breathe a sigh of relief and think that the days of adult blood lead poisoning are over."
To learn more about the ABLES program and its impact on worker health, visit NIOSH.
Kim Krisberg is a freelance public health writer living in Austin, Texas, and has been writing about public health for more than a decade.
You know the expression "What's Cheap is Expensive?" This is a cost-cutting measure that will reap costs vastly in excess of savings, by any reasonable cost-benefit assessment. But applying a values assessment to this action should result in a recognition of truly tragic developments in our national priorities.